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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 230-231

Candidial esophagitis - A marker for HIV infection




Correspondence Address:
B Kumar


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Source of Support: None, Conflict of Interest: None


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  Abstract 

A case of AIDS manifested as candidial esophagitis. In addition , he had genital herpes, frequent diarrhoea, loss of weight and generalized lymphadenopathy. The diagnosis was confirmed by endoscopy. The patient died in 3 months due to unremitting diarrhoea. This importance of candidial esophagitis in a person at risk for developing AIDS is highlighted.


Keywords: AIDS, Candidiai esophagitis


How to cite this article:
Kumar B, Rajagopalan M, Sehgal S. Candidial esophagitis - A marker for HIV infection. Indian J Dermatol Venereol Leprol 1990;56:230-1

How to cite this URL:
Kumar B, Rajagopalan M, Sehgal S. Candidial esophagitis - A marker for HIV infection. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Sep 18];56:230-1. Available from: http://www.ijdvl.com/text.asp?1990/56/3/230/3534


AIDS has already made its mark in India. More than 525 sero-positives and 25 cases are known in India.[1] We report another case of AIDS detected at our centre who presented with symptoms of difficulty in swallowing and was found to have extensive esophageal candidiasis.


  Case Report Top


A 40-year-old man was referred to our STD clinic with two years history of genital herpes and frequent diarrhoea, loss of weight and odynophagia. The patient had earlier noticed swellings in the axillae and inguinal region. Examination revealed oral candidiasis, genital herpes simplex infection, generalized lymphadenopathy and emaciation. The patient had a history of having received two blood transfusions while at Dubai four years ago. He denied any homosexual experience and also premarital or extramarital sexual contacts. All the other members of the patient's family were completely normal and asymptomatic.

A tentative diagnosis of AIDS with candidial esophagitis was made. Barium swallow revealed irregular filling defects throughout the esophagus [Figure - 1]. Esophageal specimens taken at endoscopy grew Candida a/bicans. The stools culture also grew Candida. The patient was found to be HIV positive by ELISA. Western Blot done using a Dupont kit demonstrated antibodies to all the three gene products. The T4/T8 ratio using a Dakkopats, Denmark, reagent was 0.8 and the T cell counts were significantly lower than normal. His wife was HIV negative. The children were not tested.

On treatment with oral ketoconazole (200 mg twice daily for 10 days), only the candidial growth could be controlled but the diarrhoea did not respond to any therapeutic measures. Terminally, he had rapidly worsening diarrhoea and died within 3 months.


  Comments Top


This case report highlights the gastro­intestinal manifestation of AIDS. To the best of our knowledge, this is the first known case of candidial esophagitis, reported in an AIDS patient in our Indian patient. In none of the previously reported symptomatic patients was candidial esophagitis present.[2],[3]

It is estimated that 50-93% of all AIDS patients have marked gastro-intestinal symptoms during the course of their illness[2] Diarrhoea is the most frequent.[4] The immunosuppression caused by HIV facilitates infection by a wide range of opportunistic organisms.[5] Candidial esophagitis is one such condition. It is the most frequent manifestation of fungal disease in the GIT.[6] The association of oral thrush and esophageal candidiasis approaches 100 percent.[6] Though the absence of thrush does not exclude esophagitis, all patients with oral thrush in AIDS are believed by some to have endoscopic evidence of candidial esophagitis.[7] However, in the presence of esophagitis, one must look for CMV, herpes or other,protozoans. Esophageal symptoms of Candida improve on treatment with ketoconazole or other systemic anticandida agents.

It is evident that in young patients who have opportunistic infections (especially thrush) not explained by any obvious cause, HIV infection should be strongly suspected. In the absence of a history of homosexuality or pre and/or extramarital sex, history of transfusion of blood and/or blood products in the past should arouse a high degree of suspicion of transfusion acquired HIV infection.

 
  References Top

1.ICMR : HIV infection in India - ongoing research activities and future research plans, Virus Information Exchange Newsletter, 1988; 5:396-399.  Back to cited text no. 1    
2.Malaviya AN, Singh RR, Khare SD et al : AIDS screening in north India : Clinical spectrum of HIV infection, J Assoc Phy Ind, 1987; 35:405-410.  Back to cited text no. 2    
3.Lele RD, Parekh SJ and Wadia NH : Transfusion associated AIDS (TA-AIDS) and AIDS dementia, J Assoc Phy Ind, 1986; 34:549-553.  Back to cited text no. 3    
4.Malenbranche R. Guerin JM, Laroche AC et al Acquired immunodeficiency syndrome with severe gastrointestinal manifestations in Haiti, Lancet, 1983; 2:873.  Back to cited text no. 4    
5.Rodgers VD, Fassett R and Kagnoff MF Abnormalities in intestinal mucosal T cells in homosexual populations including those with the lymphadenopathy syndrome and acquired immunodeficiency syndrome, Gastroenterology, 1986; 90:552-58.  Back to cited text no. 5    
6.Friedmann SL and Owen RL : Gastrointestinal manifestations of AIDS and other sexually transmitted diseases, in : Gastrointestinal Disease, Pathophysiology, Diagnosis and Management, Fourth Ed, Editors, Sleisenger MA and Fordtran JS: WB Saunders Company, Philadelphia, 1989; p 1242-1280.  Back to cited text no. 6    
7.Tavitian A, Rauffman J and Rosenthal LE : Oral candidiasis as a marker for esophageal candidiasis' in the acquired immunodeficiency syndrome, Ann Int Med, 1986; 104:54-55.  Back to cited text no. 7    


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